First off, depending on the program you go to will determine whether or not MSK and Rheumatology are combined into one section. Chances are, that since these guys are combined on the PANCE, they will combined at your school.
Good news? MSK is pretty straight forward!
Bad news? Rheumatology is absolutely confusing. One of our lectures literally told us not to stress to much about treatment, cause “you don’t need to know this; just call a rheumatologist”
I’m only going to talk about MSK on this post, Rheumatology will be talked about later.
- KNOW your anatomy! At my school before the start of each new section of Clinical Medicine, we do a review on physiology and pathology. Honestly, I would have much preferred to review anatomy. The best bet is to review the bones and joints of the extremities, spine and hips, and facial anatomy (you can skip the thoracic bones for the most part-these were less tested for us). Additionally, you’re going to want to understand the soft tissue parts of the joints and the role they play in movement. A majority of the things you need to know for the PANCE are going to be fractures/dislocations and soft tissue injuries for each joint.
- Practice. There are a ton of tests used to determine what kind of injury the joint has sustained. Find a partner and go through each of the tests. Use the base of anatomy knowledge you have to understand why the patient is having pain or loss of range of motion for that injury. It sounds so simple, but some of these tests are pretty confusing, and test for only very slight differences from each other.
- Make charts. I think I recommend this for EVERY section of medicine. But in regards to all of those lovely tests you need to understand and be able to preform, it can be pretty difficult to keep them all straight. A chart is really going to help.
- Brush up on your film reading abilities. Some fractures can be incredibly tiny and easy to miss, but pretty horrible for the patient if you do. Remember the steps for determining if a fracture has happened
- follow the bone cortex all the way around, it needs to be smooth!
- Cortex to cortex fractures will have a dark line
- In impacted or compacted bone fractures, the bone will appear whiter
- Greenstick fractures will not extend all the way through the entire bone, and sometimes the unbroken side will appear bent
- know when fat pads should be visible (NEVER the elbow’s posterior fat pad)
- Look to see how the bones align at a joint
I personally think that MSK is a lot of memorization and pretty straight forward. There is either a problem or not, and most of the problems don’t mimic each other which can not be said for a lot of the other systems (or RHEUMATOLOGY).
Interesting things we learned:
- Plantar Fasciitis is not caused by bone spurs, but rather bone spurs are a sign of prolonged, untreated PF.
- With a tear, the patient will still have passive range of motion up to 90°. If you go beyond that, you can cause rupture! Upside to that is at least it happened in the office instead of at home when the patient goes to do something.
- Clavicle is most often broken in children and teens from falling
- Kyphosis has NO highly proven treatment. Refer patients to PT for fall prevention
- Whiplash is always going to hurt more the day after, so prepare your patients for this
- “You could spit in a head wound and close it without it getting infected”
Hopefully this was helpful for you guys! Comment below on your thoughts about these MSK study tips, as well as any others you find helpful! I’m always looking for new ways to learn.
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